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General NPI Number Information
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NPI Number | 1114093028
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Entity Type | Organization
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Legal Business Name | JACK D COCHRAN
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 770 MAGNOLIA AVE STE 2-C
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City | CORONA
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State | CA
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Zip | 92879
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Country | US
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Telephone | 951-737-0110
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Fax | 951-737-5944
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Provider Business Mailing Address
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Address Line | 770 MAGNOLIA AVE STE 2-C
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City | COEONA
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State | CA
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Zip | 92879
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Country | US
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Telephone | 951-737-0110
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Fax | 951-737-5944
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Authorized Official
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Title or Position | OWNER
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Name | JACK DONALD COCHRAN
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Credential | M.D
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Telephone | 951-737-0110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 207R00000X
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License Number State | CA
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